1568448637 NPI number — JOHN W THOMPSON D.O.

Table of content: JOHN W THOMPSON D.O. (NPI 1568448637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568448637 NPI number — JOHN W THOMPSON D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
JOHN
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568448637
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 LIVEWELL DR
Provider Second Line Business Mailing Address:
THE MEDICAL GROUP DEPT. OF GOODALL HOSPITAL
Provider Business Mailing Address City Name:
KENNEBUNK
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04043-6762
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-985-7174
Provider Business Mailing Address Fax Number:
207-985-1304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 LIVEWELL DR
Provider Second Line Business Practice Location Address:
THE MEDICAL GROUP DEPT. OF GOODALL HOSPITAL
Provider Business Practice Location Address City Name:
KENNEBUNK
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04043-6762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-985-7174
Provider Business Practice Location Address Fax Number:
207-985-1304
Provider Enumeration Date:
12/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  1385 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 288630099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30224268 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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